I’ve been practicing fat transfer procedures for body sculpting and augmentation for a long time now; it’s a technique I’ve had great success with, and one that patients love because it allows them to make the changes they desire without resorting to implants.
Fat transfer is less invasive than implant placement, and for many patients, that’s part of its appeal. For patients who wish to make a really big change, however—for instance, women who want to turn their A-cup breasts into C-cup breasts—this procedure has not, until now, been an option. Why? Because when you’re injecting fat into the breasts, the space available is limited, which means that only a certain amount of fat can be transferred. Injecting too many fat cells can actually cause impaired blood flow and endanger the survival of transferred fat cells . . . not something you want to risk!

All that is about to change, however, according to a report in the March issue of ASPS journal Plastic and Reconstructive Surgery. The report asserts that by using Brava®, a bra-like device that uses vacuum pressure on the breast, patients can gradually expand the breast—and make themselves eligible for a much higher-volume fat transfer.

Brava’s creator, Dr. Roger K. Khouri of Miami Breast Center, and his colleagues say that a patient must use Brava (which they say is unwieldy but not painful) for several weeks before enough expansion is achieved. That said, they write in their report that they have been able to “successfully graft mega-volumes of fat into the breasts of more than 1,000 patients with substantial long-term retention” through the use of this technique.

Dr. Khouri and his coauthors used a patient with an A-cup breast size as an example: Without Brava pre-expansion, they say, someone with breasts this size would probably only be eligible for a total fat transfer of about 80 ml. With Brava pre-expansion, they say, that same patient can be eligible for up to 240 ml—triple the original amount.

The idea of “mega-volume” autologous fat transfer is a new one, but it’s certainly intriguing—and as more plastic surgeons are participating in trials using Brava, it’s something to keep an eye on!